MEDIHELP MEDICAL AID QUOTE.

Get a quote on all the Medihelp options.Send us the form below and we will email you a quote. Please complete all questions.

DO YOU HAVE TO JOIN YOUR EMPLOYER'S MEDICAL AID?

YES or NO

ONLY HOSPITAL COVER?

YES or NO I WANT DOCTOR, DENTIST, CHEMIST, GLASSES AS WELL

NAME

EMAIL

TEL

CITY

HOW MANY ADULTS

YOUR AGE

PARTNER'S AGE

HOW MANY CHILDREN

YOUR CURRENT MEDICAL AID AND PLAN

TOTAL YEARS IN YOUR LIFE YOU HAVE BEEN A MEDICAL AID MEMBER

HOW MUCH CAN YOU AFFORD EACH MONTH

ANY CHRONIC CONDITIONS

WHAT DO YOU WANT FROM A MEDICAL AID

Receive my informative letter on personal financial matters? Yes

I confirm that I have read and understood the notes below.Yes

Please note:

The submission of this quote request does not constitute any legal obligation, either on your or Peter J Pyburn's behalf. It is simply a request to get some medical aid options.

All information provided will be strictly confidential at all times and will be freely transmitted to the email address provided. Peter J Pyburn will not be responsible should the information be incorrectly transmitted or not reach the correct recipient.

Your email address will never be given to any other person or organisation.

YOU MUST CONSULT THE SCHEMES BROCHURES FOR COMPREHENSIVE BENEFIT DESCRIPTIONS AND CONSULT THE SCHEME DIRECTLY FOR ANY UNDERWRITING CONCERNS.